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Cambridge.University.Press.Fearing.Others.The.Nature.and.Treatment.of.Social.Phobia.Mar.2007.
Fearing Others Social phobia and disruptive social anxiety are features of the lives of many thousands of people But exactly what is social phobia? What causes it? What is its nature and what kinds of treatments can improve it? Using key concepts and methods and a substantive body of research, this book aims to answer these questions and clarify social phobia by means of critical discussions and examination of evidence It takes a skeptical stance towards the received view of social phobia as a species of disease caused by a deficient inner mechanism and considers and alternative construal of social phobia as a purposeful interpersonal pattern of self-overprotection from social threats The possibility that social phobia might not actually exist in nature is also considered Fearing Others will appeal to researchers, clinicians, and students in clinical and health psychology and psychiatry AR I E L ST R AV Y N S K I is Professor of Clinical Psychology in the Department of Psychology at the University of Montreal Fearing Others The Nature and Treatment of Social Phobia Ariel Stravynski University of Montreal CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521854870 © Ariel Stravynski 2007 This publication is in copyright Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press First published in print format 2007 ISBN-13 ISBN-10 978-0-511-27534-0 eBook (NetLibrary) 0-511-27534-X eBook (NetLibrary) ISBN-13 ISBN-10 978-0-521-85487-0 hardback 0-521-85487-3 hardback ISBN-13 ISBN-10 978-0-521-67108-8 paperback 0-521-67108-6 paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate To my wife and to the memory of my mother À who taught me to read Epigraph ‘‘Brave, carefree, mocking, forceful À this is how wisdom wants us to be.’’ Friedrich Nietzsche Contents List of tables Acknowledgments Preface Part I What is Social Phobia? Social Phobia: a Self-Protective Interpersonal Pattern The Genealogy of Social Phobia Part II What is The Nature of Social Phobia? page xi xiii xv 16 25 Social Phobia as a Disorder of Social Anxiety 27 Social Phobia as a Disease 67 Social Phobia as a Hypothetical Construct 75 Part III What Causes Social Phobia? 141 Social Phobia as a Consequence of Brain Defects with Graciela P ıneyro 143 Social Phobia as a Consequence of Cognitive Biases 184 Social Phobia as a Consequence of Inadequate Social Skills 225 Social Phobia as a Consequence of Individual History 246 Part IV What Helps Social Phobic Individuals? 10 The Treatments of Social Phobia: Their Nature and Effects 287 289 ix 418 Author Index Oreland, L 180, 181 Orr, S 165 Orsillo, S M 89 Orvaschel, H 172, 258 ă Ost, L G 1978, 200, 204 Otsuka, Y 180 Otto, M W 96, 109, 157, 217, 274, 324 Page, A C 118 Page, G 178, 179 Paionni, A 129 Pakiz, B 89 Pakriev, S 128, 132 Pande, A C 317 Papadimitriou, G N 168 Papageorgiou, C 204–5 Papp, L 92, 148, 151, 156, 167, 216, 218, 320, 332 Parker, G 263, 264 Parker, I 224 Parker, K 156 Partridge, F 89 Passingham, R 159 Patel, A 114–15 Paterson, R J 213, 294, 331 Pato, M T 332 Pauli, U 308 Pava, J A 108, 120 Paxton, R O 39 Pecknold, J C 218, 313 Pedersen, D 39 Peitz, M 295 ´ Pelissolo, A 16, 55, 128 Perez-Lopez, J R 199 Perna, G 154, 156, 167 Perone, A 129 Perry, K J 97, 202–3, 219, 235 Perugi, G 100, 101, 107, 117, 124, 169 Petermann, F 53, 258 Peters, L 85, 212, 214, 293–6 Petri, S 180 Phan, K 165 Philippot, P 202 Phillips, K A 111 Pickersgill, M J 29, 37, 230 Pilkonis, P 58 Pincus, A L 61 Pine, D S 113 Pini, S 108 Pinto, A 265, 268 Pipe, B 95, 163, 165 Pissiota, A 159–65, 167 Pitman, R 165 Pitts, C D 95, 309, 310 Plomin, R 173–5, 177, 247, 253, 264, 267, 282 Polat, A 165 Pollack, M H 96, 109, 157, 217, 274, 306, 309, 312, 315, 318, 324 Pollard, C A 55 Possidente, E 110, 116 Post, R 154–6 Potokar, J 148, 153, 156 Pottick, J J 64 Potts, N L 158, 159, 205, 218, 317 Poulton, R 53 Pratto, F 38 Pribor, E F 274 Purdon, C 42, 117 Putallaz, M Putman, D 28 Qamar, A B 108 Quine, W 224 Rachlin, H 30, 223, 343 Racine, Y A 126 Radke-Yarrow, M 253 Rae, D S 104 Raine, A 251 Raj, B A 331 Ramos, R 151 Ranchor, A 230 Randall, C L 110, 121 Rapee, R M 37, 86, 119, 194, 196, 198, 199, 207, 234, 263, 265, 270 Rauch, S 165 Ravaldi, C 131 Ravelli, A 128 Ravenscroft, H 196, 198 Raylor, R 77 Rector, J A 120 Regier, D A 87, 104, 108 Rehavi, M 145, 146 Reich, J 100, 101, 117, 124, 133, 169, 173 Reich, W 120 Reinherz, H Z 89 Reiss, D 247 Reiss, S 37 Renken, B 279 Renneberg, B 97 Rettew, D C 275 Rex, L L 358 Reznick, J S 101, 248, 250–4, 256–9, 262, 268, 282, 283 Rhee, H 129, 132 Richards, J C 208 Richardson, F C 231 Richichi, E 205, 218, 317 Richman, J A 77 Rickels, K 157, 158, 315 Riederer, P 180 Author Index Riemann, B C 200 Ries, B J 31, 57, 229 Rist, F 149, 153 Rivers, P C 120 Robbins, S L 69 Robins, E 78 Robins, L 87 Robinson, J L 253 Roca, M 129 Rocha, F L 127 Rodney, J M 196–8 Rodriguez, B F 196 Roelcke, V 23 Roscow-Terrill, D 154, 155, 167 Rose, R J 37 Rose, S 173, 181, 182 Rosen, J B 31 Rosenbaum, J F 108, 120, 248, 252, 256–9, 262 Rosenbaum, J R 96, 217, 324 Rosi, S 129, 131 Rosmond, R 180–1 Ross, R 75 Rosser, S 95 Rossi, A 145, 146 Rossi, M 152 Roth, D 203 Roth, W T 56, 57, 66, 98, 112, 116, 122, 134, 149, 153, 156, 195, 206, 235, 293 Rothbart, M K 247, 282 Rothgerber, H K 40 Rothschild, A J 104, 108 Rowden, L 272 Rowe, D C 253 Ruan, W J 111, 126 Rubin, K H 251, 253, 254, 269 Rubion, K H 272 Rubio-Stipec, M 127 Ruggiero, L 311 Ruotsalainen, U 150 Russell, A 269–70 Russell, B 39 Russo, A 108 Ruther, E 99, 171, 274, 275 Rutter, M 174, 177 Ryan, G M 191 Ryan, M 158–65 Ryan, N 165 Ryan, S M 270 Rydell, A M 280 Ryle, G 223 Sabol, S 180 Saboonchi, F Sachs, G 165 419 Safren, S A 51, 96, 274 Salaberria, K 215, 294, 297 Saletu, B 165 Salkovskis, P M 202 Salmoria, R 129 Salva, J J 129 Salzman, D G 214, 216 Samochowiec, A 179, 180 Samochowiec, J 179, 180 Sampson, E E 223 Samson, J A 104, 108 Samuels, J F 116 Sanborn, K 157, 158 Sanderman, R 230 Sanderson, W C 111, 119 Sandler, J 21 Saoud, J B 47, 57, 91 Sapolsky, R M 61 Sarbin, T R 33–5 Sareen, J 104, 159–65, 167, 310 Sartorius, N 86, 87 Savino, M 100, 101, 108, 169 Scarpa, A 251 Scarpato, A 129, 131 Scarpato, M A 131 Schaettle, S C 218, 309 Scharpe, S 151 Scharwachter, I 309 ă Schatzberg, A F 104, 108, 156–8 Schlenker, B R 37 Schlick, J 128, 132 Schmidt, L A 60 Schneider, F 159, 162 Schneier, F R 51, 88, 107, 109, 110, 114, 127, 132, 146, 150, 216–8, 308, 320, 323, 328, 331, 332 Schoenbach, V J 274 Scholing, A 28, 97, 121, 212, 293, 294, 296, 297, 332, 334 Schroeder-Hartig, K 228, 238, 240, 244, 302, 330 Schubart, UK 182 Schuckit, M A 110 Schulkin, J 31 Schwalberg, M D 109, 121 Schwartz, C E 102, 261, 262 Schwartz, G E 191 Schwartz, M A 69 Schweizer, E 157, 158 Sebag Montefiore, S 39 Seedat, S 320 Semlitsch, H 165 Sengun, S 37, 66, 105, 118 Serlin, R C 313 Shapira, B 151 Sharifi, N 147, 151 420 Author Index Sharma, S 157 Shaw, K 271 Shaw, P M 119 Shea, T 275 Shean, G D 205 Shear, M K 35 Sheehan, D V 71, 331 Shepherd, M 64 Sheridan, J F 41 Shibuya, H 180 Shiloh, R 90 Shin, L 165 Shin, R.-Y 182 Shlik, J 146, 150 Shriqui, C 154 Shrout, P E 127 Shulman, S 278, 279 Shumyatsky, G B 182 Sidanius, J 38 Sidoun, P 240, 242, 244, 245, 300, 301, 303, 304, 329, 330, 358 Siegel, J 307 Sigman, M 265, 268 Silove, D 103 Silva, P A 53, 89, 172, 262 Simeon, D 147, 150 Simon, N 157 Simonini, E 100, 101, 108, 117, 124, 169 Sjodin, I 315 ¨ Skinner, B F 351 Skodol, A E 275 Skre, I 87, 175 Slaap, B 155, 167 Slade, T 85, 106, 115, 130 Slate, S 154, 155, 167 Slate-Cothren, S 154–6 Slee, P T 272 Slutske, W S 274 Smith, P R 40 Smith, R 159, 160, 205, 218, 317 Smith, W T 314 Smulders, D 267 Snaith, R P 46 Snidman, N 102, 248, 250–2, 256–9, 261, 262, 268, 282, 283 Socci, C 117, 124 Sofsky, W 38 Sonninen, P 150 Sonntag, H 114 Sorenson, J 159 Sowa, B 126 Spaulding, S 97, 332 Spence, S H 37 Spitzer, R 68 Spitznagel, E L 84 Sprigge, T L S 33 Spurr, J 152 Sroufe, L A 182, 247, 276–80, 282, 283 St Lambert, J 311 Stang, P 108 Stangier, U 295 Stanton, W 53 Statham, D B 274 Statman, D 36 Stattin, H 251 Steer, R A 186, 187 Stefanson, J G 127 Stein, D J 9, 95, 147, 150, 161, 308, 309, 311, 312, 316 Stein, M B 22, 53–5, 66, 91–3, 95, 99, 101, 104, 108, 115, 118, 126, 145–8, 150–3, 159–65, 167, 168, 170, 172, 178, 179, 265, 275, 306, 309, 310, 312, 315, 318, 320 Stender, K 316 Stepien, G 179, 180 Stevenson, J 290 Stevenson-Hinde, J 58, 283 Stewart, S L 251, 253, 254, 269 Stich, S 224 Stinson, F S 111, 126 Stober, G 180 Stone, W L 271 Stopa, L 152, 187, 195, 197, 203 Storch, E A 273 Stout, R L 111 Straub, R 156 Straube, T 159–65, 167 Strauman, T 47, 57, 91 Strauss, C C 52, 256 Stravynski, A 14, 37, 45, 66, 72, 105, 118, 123, 133, 214, 225, 227, 239, 240, 242, 244, 245, 264–6, 274, 300, 301, 303, 304, 329–31, 334, 347, 358 Street, L L 89, 114 Sullivan, G 168 Sullivan, L 159–65 Summerfeldt, L J 273 Summerville, W 152 Sunitha, T 145, 146 Surawy, C 187, 204, 209, 221 Sutherland, S M 97, 218, 317 Swartz, K L 85 Swindell, A 208 Swinson, R P 42, 117, 120, 203, 218, 273, 281, 306, 313 Syvalahti, E 150 Szasz, T 70 Szatmari, P 99, 171 Szechtman, H 163, 165 Author Index Taggart, P 152 Tait, R C 191, 192 Takahashi, T 21 Tamaren, A J 192 Tancer, M E 92–3, 99, 101, 118, 147, 148, 150–4, 157, 165, 168, 170, 172, 179, 216, 217, 310, 322 Tasto, D L 231 Taylor, B 101, 261 Taylor, C B 293 Taylor, L H 318 Taylor, S 213, 294, 331 Tedlow, J R 108, 120 Telch, M J 260 Teufel, A 180 Tezzcan, E 320 Thakore, J 147, 151, 157, 158 Thase, M E 304 Thevos, A K 110, 121 Thomas, A 247–8, 282 Thomas, K 165 Thomas, S E 110, 121 Thompson, R A 277 Thornton, L 109 Tiihonen, J 150 Tillfors, M 45, 55, 128, 159–65, 167, 180, 181, 268 Tipp, J E 110 Todorov, C 45, 133, 240, 242, 244, 245, 300, 301, 303, 304, 329, 330, 358 Tokizawa, S 182 Tomarken, A 149, 153, 165 Toni, C 107, 117, 124, 159 Torgersen, S 87, 128, 175 Torgrud, L J 115, 126 Toru, M 180 Townsend, J T 48, 186, 219, 222, 223 Townsley, R M 88, 98, 123, 134, 206, 237 Trabert, W 293 Trainor, P 53 Tran, G Q 96, 122, 134, 237 Travers, J 22 Treat, T A 186 Treffers, P D A 53 Trower, P 53, 226–8, 236 Tru, I 146, 150 Truglia, E 131 Tsvetkov, E 182 Tukel, R 117, 124, 165 ă Tully, K 182 Tupler, L A 89, 97, 115, 159, 160, 218, 317 Turk, C L 31, 57, 204, 229 Turner, R M 421 Turner, S M 50, 56, 88, 91, 98, 99, 101, 123, 134, 172, 194, 206, 237, 255, 323 Turski, P 159 Tweed, J L 274 Tyrer, P 75, 77, 137 Uchoa, E 127 Uebelacker, L A 108, 120 Uhde, T W 72, 92–3, 118, 147, 148, 150–5, 157, 167, 168, 216, 217, 322 Unal, A 320 Unal, S 165 ă ă Ustun, B 86 Valenca, A M 116 ¸ Valevski, A 90 van Ameringen, M 95, 99, 163, 165, 171, 218, 260, 275, 306, 313 van Dam-Baggen, R 303, 304 van de Ven, M 260 van Den Hout, M 156 van der Ende, J 229, 230 van Der Helm, M 212, 295 van der Model, H T 230 van der Molen, H 230 van der Sleen, J 212, 239, 302, 330 van Drimmelen, J 86 van Hout, W J P J 28 van Hunsel, F 151 van Lier, P 53 van Oosten, A 267 van Praag, H 150 van Velzen, C J M 97, 121 van Vliet, I M 155, 167, 308, 311, 317 van West, D 151 van Zessen, G 128 Varady, S 157, 158 Vasar, V 128, 132, 146, 150 Vasile, R G 89, 106 Vaudry, H 151 Vega, W A 126 Veit, R 159–65, 167 Velayudhan, A 145 Venables, P H 251 Vermilyer, J A 214 Vernberg, E M 272 Versiani, M 97, 218, 319 Vieira, A 151 Vigliaturo, D 129 Viken, R J 186 Vissia, E 212, 295 Vittone, B 150, 157, 216, 217, 322 Vivani, B 129 Von Zerssen, D 128 Vorcaro, C M 127 Vronskaya, S 182 422 Author Index Wacker, H R 129, 132 Wagner, L 77 Wakefield, J C 64 Walker, J R 54–5, 99, 101, 115, 126, 170, 172, 179, 218, 275, 306, 313 Wall, S 276 Wallace, C J 226 Wallace, S T 195, 196, 235 Walters, E E 108 Walters, K S 195, 236, 271 Ware, M R 145, 146 Warner, G 318 Warren, M 89 Warren, S L 280, 283 Warshaw, M G 111, 133 Waters, E 276 Watson, D 48–50, 193–4 Watt, I 333 Wedig, M 165 Wedkin, D 99, 171, 274, 275 Weidmer-Mikhail, E 151 Weihs, K 314 Weiller, E 106, 110, 114, 131 Weiller, F 147, 150 Weisler, R H 317 Weiss, U 159 Weissman, M M 107, 109, 110, 127, 132 Weizman, A 145, 146, 156 Welch, K 151 Welkowitz, L K A 216, 217, 323, 328, 331 Wells, A 187, 204–5 Wells, J E 130 Weltzin, T E 121, 124 Wender, A 235 Wessberg, H W 233 Wessel, I 28, 260 West, C 150 Westenberg, H G M 53, 151, 155, 167, 308, 311, 312, 317 Wetzler, S 111, 151 Whalen, P 165 Whaley, S H 265, 268 White, C S 98, 120 White, K 133 Wick, P 271 Widiger, T A 75 Wiebelink, B M 53 Wiggins, O P 69 Wiita, B 309, 312 Wilhelm, F H 57, 66, 109, 149, 153, 156, 291 Wilhelm, S Williams, J H G 42 Williams, M 224 Williams, S 89, 130, 172 Wilson, K G 34 Wilson, P 46, 333 Wilson, S 148, 153, 156 Wilson, W H 205, 218, 317 Wittchen, H U 53, 55, 87, 104, 107, 108, 114, 127, 128, 131, 132, 265 Wittgenstein, L 224 Wlazlo, Z 228, 238, 240, 244, 302, 330 Wold, J E 314 Wolf, A 43 Wolff, P L 97, 262, 332 Wolpe, J 105 Wong, M 126 Woodman, C L 117, 124 Woodruff-Borden, J 265, 268 Woods, S 101, 178, 179, 213, 294, 331 Woody, S R 196, 199 World Health Organization xv, 67, 68 Worthington, J J 96, 108, 120, 157, 217, 324 Wreford Andersen, E 316 Wright, C 165 Xidara, V 43 Yamada, K 180 Yamamoto, J 129, 132 Yang, H 312 Yao, S N 295, 331 Yates, W 100, 101, 169, 173 Yeh, E 129 Yehuda, R 156 Yen, S 275 Yin, D 182 Yonkers, K A 113, 133 Young, A 77 Youngstrom, E A 31, 43–4 Yule, W 214, 239, 244, 303, 304, 329–31, 334 Zaccagnini, J 151 Zachar, P 349 Zakharenko, S S 182 Zanarini, M C 275 Zaudig, M 128 Zea-Ponce, Y 146, 150 Zentner, M 181, 182, 284 Zhang, H 115 Zhang, J 315 Zhao, N 312, 325, 327 Zhao, S 127, 132 Zimbardo, P 58 Zimmerman, M 114, 117, 124 Zin, W A 116 Author Index Zohar, J 332 Zohar-Kadouch, R 332 Zollo, L J 329 Zorrilla, L 159–65, 167 Zucchi, T 129 Zucker, B G 109 Zucker, M 145, 146 Zweig, D R 189, 190 423 Index acedia 77 adolescence trigger events in 246 onset of social phobia 258, 350 adrenaline 151, 152 aggressive behavior, lack of 61 agoraphobia 14 measurement studies 92–3, 204 shared features 105, 136, 137 Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), see WHO/ADAMHA alcohol, use in treatment 19, 23 alcoholism 104, 110, 137, 349, 350 of parents 274 alprazolam 217, 322–7 amygdala hyperactivity 159, 165, 168 analytic philosophy 224 Anorexia Nervosa anthrax, and terrorism 32 anxiety contrast with fear 30–1 in social context 31–2 definition of 30, 34, 35 emotion 30, 31 genetic component 71–2 short alleles 180–1 intra-personal conception of 63, 292 lay construct of 52, 64 manifestations of 33 measurement of 46 reduction strategies cognitive restructuring 291–9, 329 evaluation of 328 exposure 291–9, 328, 346, 357 and social functioning 329–31, 358 scientific construct 34–5 social interactive perspective 62–3 see also clinical anxiety; fear anxiety-neurosis 18, 77 anxious withdrawal, index of 102 424 anxiously attached children 277, 279 and social anxiety 280–1 submissiveness of 280 APA, disorders or diseases 73 appeasement Asian v Western culture, and behavioral inhibition 251–2 atenolol 97, 216, 218, 306, 319–20, 322–7, 332 attachment 275–6, 344 as opposed to temperament 282 common features with behavioral inhibition 283–4, 345–6 infant temperament 278 patterns of relationships 277–8 long-term implications 278 quality of 279–80 role in social phobia 281, 282 The Strange Situation 276–7, 279 attachment relationship, importance of 62 attention bias identification of angry/happy faces 201–2 lexical tasks 199 homographs 201 modified Stroop task 199–200 latency 200 under levels of discomfort 200–1 attention, escaping of Audience Sensitivity Index 50, 194 Australian National Survey of Mental Health and Well-Being 106, 130 authority, fear of 54 automaticity 186 autonomic responses 91 avoidance behavioral sign of social anxiety 48–9 of social interactions 7, 61 see also social avoidance avoidant disorder of childhood or Index avoidant personality disorder 57, 124, 137, 170 and sexual coercion 275 and social skills deficits 237 and social skills training 240–1 avoidantly attached infants 277 behavior patterns formulation of construct 78, 137 inhibition, study of 102–3 differences between sexes 103 behavioral assessment tests (BAT) 134 behavioral inhibition 248, 255, 344 and anxiety disorders 248 association with social fears 262 common features with anxious attachment 283–4, 345–6 evidence against construct social/non-social inhibition 253–4 use of extreme scoring individuals 254–5 evidence for construct 251 correlates of behavioral inhibition 252–3 differing cultural values 251–2 heredity 253 predictive features 253 reliability 252 validity 253 experiments of 249 inhibited/uninhibited profiles 250–1 links with adult social phobia 261, 281, 282 parental influence 268–9 physiological measurement 250 precursors to construct 259–60 retrospective studies 260–1 studies of 248–9 see also attachment; childhood social phobia; index of behavioral inhibition temperament behaviorism, clash with cognitivism 292 benzodiazepines 145, 166, 305, 307–20 biochemical abnormalities, and anxiety 71–2 blushing 4, 5, 7, and heart rate 57 phobia 19, 27, 348 Body Dysmorphic Disorder 109 botox, and paroxetine 358 brain function, and neuroimaging 159–65 brain structure 159 breathing, fast 6, 7, 20, 28, 348 Brief Social Phobia Scale (BSPS) 205 brofaromine 218, 307–18, 331 425 bullying, see victimization buspirone 166, 217, 305, 307–18, 322–7 cardiovascular functions, measurement of 91–3 catecholamines 72, 152 causation, Aristotelian 342 analysis of final causes 342–4 childhood adversity, and later psychological problems 275 childhood social phobia and anxiously attached infants 280 flaws in studies of 258–9 indicators of 255–6, 354–5 link with behavioral inhibition 256 comparisons using parents with anxiety disorders 257–8 family members 257 predisposition to social phobia or avoidant disorder 258 prevalence rates 256 relation to avoidant disorder 256 childrens’ fears 37 separation from caregiver 44 of strangers 44 Chronic Fatigue Syndrome 77 citalopram 150, 319–20, 331 clinical anxiety 28, 44 definition of 45 clonazepam 94, 96, 97, 160, 217, 218, 307–20, 322–7, 331 clonidine 151, 152 CO2 provoked panic, cognitive processes compared 207 cognition 90 clinical use of term 185 manifest in actual behavior 188 meaning of 185, 186, 219 see also behavioral cognition; cognitive behavior therapy; thought processes cognitive and somatic anxiety questionnaire (CSAQ) 191 convergent validity 191–2 differences between social phobic subtypes 206 internal consistency 191 predictive validity 192–3 cognitive behavior therapy (CBT) 292–9, 328, 329, 332 see also cognitive modification techniques; cognitive therapy and cognitive changes cognitive biases and social phobia 187, 222–3, 344 beliefs 223 in common situations 184 426 Index definition of 219–20 differences between sub-groups of social phobics 205–7 maintenance of social phobia 209, 221–2 responses to Interpretation Questionnaire (IQ) tests using imagery 209–10, 221 separation of agent and environment 223 category mistake 223 see also cognitive model cognitive distortions, specific to disorders 207–9, 220–1 cognitive model 187 and anxiety 186–7 attention biases 199–202 behaviorism 186 Cartesian philosophy 224 imagery 204–5 judgment biases 202–3 memory biases 196–9 negative self-appraisal 194–6 cognitive modification techniques 211–15 cognitive behavior therapy compared to pharmacotherapy 216–18 compared to behavioral treatments 211 compared to cognitive behavior therapy 211–16 cognitive science 185, 220 and therapy 186 cognitive therapy and cognitive changes, comparison with other treatments 211–16, 222, 239, 293–8, 332 communication problems 27 competitive activities, fear of 11, 12, 37 competitive societies, and social anxiety 62–3 concentration, lack of 27 see also diminished responsiveness concurrent validity, of the construct of social phobia and age of onset and sex 88–9 demographic factors 89–90 and neurobiological factors 93 and psychological factors 90–1 and psycho-physiological patterns of responding 91–3 confrontation, fear of construct validation 81–2 content validity 80–8 criterion validity 80–2, 88–104 measurement 78–9 predictive validity 93–104, 137 relationship to other psychological constructs 83, 105 factor-analytic studies 105 testing 79 control, and social skills 227 convergent validity, of construct 81–3, 105 cortical control, and social phobia 159–65 cortisol 151, 154 and HPA axis 157 cramps 28 cultural differences, in social phobic patterns 13–14, 269 Darwin, and origins of social fears 42 demographic factors, and social phobic individuals 89–90 Demosthenes 18 depression, links with social phobia 104, 113, 137 cortisol responses 151 prevalence among relatives 169 recovery rates 114 and social skills 227 Descartes 33, 344 diminished responsiveness 7, 20, 348 discipline, by parent 267 discriminant validity, of construct 81–3, 105–25 discrimination, social systems of 39 disease, and social phobia 67, 70–4, 139, 339–40 definition of 68, 70 or disorder 68–9 pathological definition 69–70 use of terms in medicine 69 and psychotropic medication 72–3 disorders definition of 68–9, 75–6 links between 105 metaphoric disease 70 dissembling 7–8 dominance, and submission 35–6 drug abuse, prevalence among relatives of social phobics 169 DSM (Diagnostic and Statistical Manual) defining criteria of social phobia 75, 76 rates of reliability 85 dualism, and cognitive program 224 dysfunctional thought cognitive and somatic anxiety questionnaire (CSAQ) 191–3 measurement of 188–9 social interaction self-statement test (SISST) 189–91 early separation anxiety 103–4 eating disorders see also social phobia Index electrophysiological studies of social phobics 165 emotion and anxiety 30 and attachment theory 276 emotional conditioning studies 162 employment, and social phobic individuals 114–15 environmental conditions, and anxiety 41–2 epidemiological studies of social phobia 125–32, 135 ecological validity 133–4 patterns of psychopathology 133 predictors of response to treatment 95–8 reliability 86–7 support for entity hypothesis 136 ambiguous 136–7 undermining evidence 137–8 variability in prevalence rates 132, 138 within the USA 132–3 ereutophobia, see blushing phobia escitalopram 307–18, 331 etiology, in construct validation 78 external validity, of construct 81–3, 125–35 family environmental influences 263–6, 270–1 low-care 266 overprotection 263–6 see also family sociability; shyness; social phobic parents family sociability 266, 267 and children’s shyness 267 influence on children’s sociability 270 fascist Italy, and intimidation 38 fear and anxiety 30–1, 338 attempts to understand xvi–xvi common fears 28 core of social phobia 16–17 in formal/institutional situations 10 group membership 10–11 hiding of physical manifestations of 7–8, 21, 348 historical approaches to 17–18 and lack of danger 27 of others 4–5 and shame 19 and social danger 42 of strangers 11–12 Fear of Negative Evaluation (FNE) 190, 192, 193, 211, 216 convergent validity 194 discriminant validity 194 427 predictive validity 194 reliability 193 Fear Survey Schedule 52, 105 fearfulness, as predictor of social phobia and depression 101–2 Fels longitudinal program 259 fenfluramine 150, 151 fluoxetine 95, 305, 307–18, 322–7 fluvoxamine 307–18, 331 Freud and anxiety 30 and fear 18 functional approach, in treatment of social phobia 299–300 gabapentin 166, 305, 307–18, 331 general neurotic syndrome 137 generalizability, of construct 125, 139 epidemiological studies 125–32 patterns of psychopathology 133 generalized anxiety disorder 165 generalized social anxiety assessment of 103 association with other anxiety disorders 105 predicted by social phobia 113 genetic transmission of social phobia 23, 246, 344, 345 and behavioral inhibition 262 and environmental conditions 246 see also temperament Goldstein, and anxiety 30 groups membership of 40 relationships of members 11 habituation, principle of 291 hair raising 7, Hamilton Anxiety Scale 51 Hamilton Depression Scale 51 hands, trembling of 20 harmful acts, on fellow humans 37 by bands 38–40 headaches 7, 28 heart rate, and public speaking 57 Hippocrates 17, 18 history, of individual social phobics 246, 247, 260 Hobbes 40 homosexuality, relabeling of 77 Horney, and anxiety 30 Hume, primacy of feeling 224 humiliation, fear of 13 hyperthyroidism 157 hypothetical constructs 77, 337 validation of 77–83, 138–9 428 Index ICD (International Classification of Disease) definition of social phobia 75, 76 reliability rates 85 illness behavior, as predictor of depression 101 imagery, tests of social phobics detail of recall 204 recall tests 204 seeing from outside 204, 205 index of behavioral inhibition (IBI) 249, 250 individual differences between social phobics 15 inhibitory neurotransmitters 72 Interpretation Questionnaire (IQ) 210, 219 intimate relations, and social phobia 12 Irrational Beliefs Test (IBT) 190, 192 isolation, of parents 266 Jackson Personality Research Form 50, 194 Japanese samurai, and social anxiety 63 judgment biases ambiguous situations 203 observable features of social phobia 203 Probability Cost Questionnaire (PCQ) 202 of social/non-social events 202, 203 kappa statistic 84 interpretation of 84 leeches, use in treatment of social phobias 19, 23 Lenin 70 levodopa 151 loneliness, and fear low-care in childhood 266, 267 lymphocite beta adrenergic receptors, measurement of 145 magnetic resonance imaging (MRI) 157 marital difficulty, as result of social anxiety Marlowe-Crowne Social Desirability Scale 50, 194 marriages, arranged, and social phobia 14 Marx, and consciousness 224 maternal behavior, influence on childhood social behavior 269–70 m-CPP 150, 151 measurement reliability 79, 80 calculations of agreement 84 on features of entity 88 types of assessors 85 rates of 85 medicalization, of experience of fear 17 meeting new people, fear of 54 melancholia 17 memory biases, specific to social phobia 197 completion rates 198 implicit/explicit memory tasks 197 recall of negative elements of feedback 197 recall and recognition task 197, 198 mental state, as psychological construct 33–4 military society 39 Mill, J.S 78 Missouri Adolescent Female Twin Study 120 moclobemide 94, 95, 97, 305, 319–20, 331 and placebo effect 167, 218, 305, 307–18 monoamine oxidase inhibitors (MAOI) 166, 305, 307–18 muscle tension 6, 20 National Comorbidity Survey (NCS) 108, 127, 132 National Epidemiologic Survey on Alcohol and Related Conditions 111, 126 naturalistic approach, to social phobia xvi, 16–17 neck and shoulder stiffness 7, 28 negative self-appraisal in social phobics 194–6 perceptions of success 195 response to positive environmental influences 196 neurasthenia 18 neurobiological formulation of social phobia 143–4, 167–8, 182–3, 344 identification of abnormalities 144–5 pharmacological treatment 165–7 principles of 144 neuroendocrine function hypothalamic-pituitary adrenal axis 156–8 hypothalamic-pituitary thyroid axis 157 neuroimaging methods 150, 157–65, 168 neurological disease explanation of abnormality 70–1 and social phobia 72, 143–4, 340 neurotransmitter systems activation by means of pharmacological agent 146–8, 150–2 DA transporter sites in social phobics 150 direct measurement of 145–50 neuroimaging methods 150 Index neurotransmitter systems (cont.) panic-inducing agents 153–5 caffeine-dependent 154 cholecystokinin-dependent 154–6 CO2-dependent 156 lactate-dependent 154 postural challenges 152–3 observation, and construct formulation 78 obsessive-compulsive disorder comparisons with social phobia 210–11 link with social phobia 105 occupations, and social anxiety 20 olanzapine 166, 305, 307–18 opium, use in treatment of social phobia 19, 23 overall percentage of agreement 84 overanxious disorder 280 overprotective parents 263–6 palpitations 6, 7, 19–20, 28, 348 panic fear of 27 chemically induced 153–4 measurement of anxiety 46 panic disorder 165 comparisons with social phobia 92–3, 156, 207 cortisol responses 151 recovery rates 114 and sexual coercion 274 parental influence, on development of social behavior 269–70, 284–5, 354 parental loss or separation 274 parental strife 274 paroxetine 95, 218, 307–20, 331 with addition of botox 358 passivity see also behavioral inhibition patterns of behavior, and final causes 342–3 patterns, of social phobia case descriptions 4–6 long-term 243 pedophilia, cortisol responses 151 peer environment popularity 271, 272 shyness 271, 272 see also bullying performance difficulty (SAS) 50 personal history, of social phobics 15 Pervasive Developmental Disorder pharmaceutical companies, marketing campaigns and social phobia 73, 183 429 pharmacological treatment of social phobia 307–18, 332 adverse effects 306, 321, 332, 358 marketing departments and designation of medication 304 monoamine oxidase inhibitors (MAOI) 305, 307–18 and placebo effects 305–6, 331 psychotropic compounds 304, 331 selective serotonin reuptake inhibitors (SSRIs) 305, 307–18 suppressants of neural excitability 305, 307–18, 346 pharmacotherapy, compared to placebo 216 phenelzine 216–18, 306, 319–20, 322–8, 331, 332 phobia classification of 19 historical background 17 platelet transporters, measurement of 145 Plato, and cognition 185 positive parental experience 266 Positron Emission Tomography (PET) 157 post-traumatic stress disorder 77, 165 power, in social interactions 35, 36, 352–3 of ruling groups 38–40 predictive validity, of social phobia construct 95–8 and alcoholism 104 and depression 104 family history 94–101 children of social phobic parents 101 pharmacological treatment 94 prospective studies 101–3 pregabalin 307–18, 331 Price Foundation Collaborative Genetics Study 109 Probability Cost Questionnaire (PCQ) 219 Project MATCH 121 prolactin 151 propranolol 322–7 propriety, standards of protection from danger, and attachment theory 276 psychiatric disorders, existence of 75–6 psychological approach, to treatment of social phobia 23 psychologization, of experience of fear 18 psychopathology, history of 77 psychotropic medication 72–3, 97 public speaking, fear of 54–5, 66 measurement of social anxiety 56–7, 163–4 in Stroop test 200–1 430 Index punishment, patterns of 284 pupils, dilation of queasiness quinagolide 151 reductionistic programs, and causes of social phobia 344 regional cerebral blood flow (rCBF), changes in 159–65 rejection, by parent 266, 267 respiratory function, measurement of 91–3 retrospective self-report of behavioral inhibition (RSRI) 260, 261 reversible inhibitors of monoamine oxidase (RIMAs) 305, 319–20 rigid rules, and child behavior 270–1 Robbins Pathological Basis of Disease 69 role-play tests molar 231 molecular 231 simulated social interaction test (SSIT) 231–4 Scale for Interpersonal Behavior (SIB) 229–31 schizophrenia, and social skills 226 Schoppenhauer xvi securely attached infants 277 security in being liked selective serotonin reuptake inhibitors (SSRI) 150, 166, 305, 307–20 self-disparagement separation anxiety 276, 280, 354 organized response 276 uncertainty of availability of caregiver 278 sertraline 95, 218, 307–18, 331 sex differences, chronic social phobia 113 sex distribution, of social phobics 89 sexual coercion in childhood 274–5 sexual functioning 79, 90, 110 and social skills 227 sexual history 90 shaking, fear of 27 shyness in adults 60 and anxiety 20 comparisons of 57 adolescents and young adults 59 children 58–9 link with adult social phobia 60 and parental discipline 267 as predictor of social phobia 102 relationship with sociability in children 59–60 social 36 simulated social interaction test (SSIT) 231–3 concerns over validity of test 232 identification of common difficulties 231–2 lack of generalizability 232 single photon computed tomography (SPECT) 150, 157 situational phobias 19 skin conductance, measurement of 91–3 social anxiety xvii, 4, 338, 352 among adults 54–6 comparisons of 56 among children and adolescents 52–4 comparisons of 56 among students 53 commonplace 66, 338 degrees of 42–4, 338 individual differences 43–4 interpersonal locus of 20 intra-personal construction 64–5 link with cognitive processes 205 measurement of 21, 29, 46 and fear response 46–7 exclusion of behavior 47–8 parental behavior 266–8 and schizophrenia 21 self-reported scores 45 social phobic pattern of conduct 6, 19, 44, 61–6, 338, 353–4 somatic loans of 6–8, 13, 22, 338 unidentified danger 37 see also anxiety Social Anxiety Scale (SAS) 48, 50–2 reliability 51 validity 51–2 Social Avoidance and Distress (SAD) 48–50, 190, 192 reliability 49 validity 49–50 social avoidance, as prediction of social phobia 101–2 social contact, in infancy and childhood 40 social danger, and environmental conditions 41–3 social difficulty 50 social environment 355 and social phobia 263 social fear, definition of 35, 37 social functioning, treatment and improvement 301–3, 347, 358 evaluation of 329–31 functional 299–300 Index social functioning, treatment and improvement (cont.) results 300–4 structural 299, 300 social skills training 300 social gatherings, fear of 54 Social Interaction Anxiety Scale 51 Social Interaction Self-Statement Test (SISST) accuracy of measurement 189 convergent validity 189–90 differences between subtypes of social phobia 206–7 discriminant validity 190 frequency of occurrence of thoughts 189 levels of social anxiety 205 social life, necessity of 40–1 social phobia 337 affective disorders 107–9, 120, 124, 341, 350 age of onset 21, 88–9, 350 anxiety disorders 106–7, 124, 136, 341, 350, 351 categorical and dimensional approaches to 23–4 causes xviii–xviii, 23, 284, 342–6, 351–7 chronic 113–14 dangers evoking self-protective measures 348, 356 definition xvii–xvii, 3, 75, 137, 347–9 differing perspectives 16–17 demographic factors 89–90 distinct from alcoholism 121 distinct from avoidant personality disorder 121–3, 341 distinctiveness from normality 112–13, 137, 138, 350 dual locus 23, 62, 348–9 eating disorders 109, 121, 124, 341 economic, educational and social consequences 114–15 entity hypothesis 135, 340–1 environmental conditions 284–5, 356 plus other factors 285–6 family history of 99–100 genetic marker studies 174, 178 association studies 178–81 linkage analysis 178, 179 genetic vs environmental factors 173, 181–2 in twin studies 176 high-risk children 171–2 history of term 16, 17, 63, 162 indicators interpersonal cluster of fears 29, 64 431 lack of theory 139, 168, 337 links with other hypothetical constructs 137, 341 long-term patterns of behavior 243, 244, 355 nature of xvii–xvii, 27, 63, 66, 225, 337–42, 349–51, 356 and personality disorders 111, 124, 341, 351 predictions from social avoidance scores 261 prevalence among adults 126–31, 289, 341 prevalence among relatives 169–73 rate of consultation 114 sex distribution 89, 350 and social anxiety disorder 22, 64–6, 338, 346, 350 social functioning 242, 351 in pursuit of different goals 242–3 subtypes of 22 treatment xviii, 23, 29, 95–8, 137 twin studies 174–5 factor independence 177 lack of environmental evidence 176–7 notion of heritability 177–8 using psychiatric patients 175 using subjects not seeking help 175–6 validity xvii–xviii see also behavioral inhibition; childhood social phobia; construct validation; disease; epidemiological studies; social anxiety; social skills Social Phobia Scale 51 social phobic parents 268 social situations, avoidance of 27 social skills assessment of interpersonal approach 229 intra-personal approach 228–9 role-play tests 231–4 self-rating 229–31 subtypes of social phobia 236–8 comparisons of social phobics and others 234–8 getting acquainted 235 public speaking 234–5 speaking to interviewer 235 concept definition 227–8, 234, 236 deficiency 90, 226, 243–4, 344, 345 elements of 227 lack of 225 links with social phobia 241–2 notion of 226 recognizability of 228 432 Index training in 238–9, 241, 244, 245, 300, 330 improvements in skills 239–40 need for 240–1 non-defensive methods of dealing with situations 244 somatic reactions experienced by social phobics 143 regulation by brain processes 143–4 vicious circles 187 Sophocles speech difficulties 6, 20 St John’s Wort 305, 307–18 Stalinist repressions 41 stammering 5, 59, 348 Stanford Shyness Survey 58 status, in social interactions 35–352, 353 and shame/humiliation 36 Strange Situation, the 276–7 Stroop test 199–200, 207–8 submissiveness 79 sweating 6, 7, 19, 28, 348 thyrotropin 93 training, see social skills training treatment of social phobia comparison of psychological and psycho-pharmacologic treatment 306–28, 332–4 demand for 333 distinction between specific and generalized 332–3 psychological anxiety reduction 291–9, 328, 357 dropout rates evaluation of 328–31 improvements in social functioning 299–304, 329–31 predictors of response 95–8 psycho-pharmacological 304–6 valuation of 289 outcome considerations 290–1 requirements for 289–90 Tully 18 Taylor Manifest Anxiety 50, 194 temperament definition of 247–8 four categories 248 as opposed to attachment 282 perspective on development 281–2 thought processes, tests of comparisons of social phobics with panic disorder subjects 207–8 comparisons of social phobics with obsessive-compulsive subjects 208–9 nature of 187 validity of 185 urge to urinate 6, 7, 20, 28, 348 vagus nerve, and CCK receptors 156 Valsalva maneuver 91 venlafaxine 306–18, 331 victimization 271–3, 280 violence between parents 274 World Health Organization (WHO) social phobia as disease 73 WHO/ADAMHA field trials 86–7 writing, fear of 5–6 Yule’s Y 84